Provider Demographics
NPI:1073947768
Name:BROWN, TIMOTHY RYAN (DPT)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:RYAN
Last Name:BROWN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1438 HARDCASTLE BLVD
Mailing Address - Street 2:
Mailing Address - City:PURCELL
Mailing Address - State:OK
Mailing Address - Zip Code:73080-8233
Mailing Address - Country:US
Mailing Address - Phone:405-527-4700
Mailing Address - Fax:405-767-8941
Practice Address - Street 1:1921 STONECIPHER DR
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-3439
Practice Address - Country:US
Practice Address - Phone:580-310-5687
Practice Address - Fax:580-421-6283
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5054225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist